1. Engelhardt et al., 2010

2. 70 pat. With BPS and HA therapy between 2001 and 2003 received a questionnaire (VAS) to evaluate the present status (at 2008) Patients had previously a high symptom remision rate at short-term (>80%)

3. Results: 48/70 responded to the questionnaire Mean follow-up of 4.9 years 8.15 before therapy VAS 2.71 after therapy (Short –term) 2.14 Long-term (after 5 years)

4. 1) Patients evaluation: 50% of patients (24/48) were still free of bladder symptoms at 5 y. follow-up, without any additional therapy after the initial instillation series

5. 2) Patients evaluation: 41.7% of patients (20/48) symptoms recurred within the first year after instillation therapy. 25% were free of symptoms after receiving HA maintenance alone (12/48) 16.7% were free after receiving HA in combination with oral PPS (8/48)

6. 3) Patients evaluation: 8.3% of patients (4/48) no change of symptoms

7. Conclusion: Besides a high rate of acute symptom remision, Hyaluronan also shows long-term efficacy in a considerable number of BPS patients, what suggests that some patients may be cured by this therapy

8. VAS reduction: > 2 in 85.4% of patients (41/48) < 2 in 6.25% of patients (3/48) No improvement in 8.3% (4/48)

9. Hyaluronan reinforces the urine-tissue barrier by integration in the GAG-layer on the luminal surface and the base of urothelial cells, a part of other actions, like the anti- inflammatory effect Hyaluronan long-term therapy has no adverse effects and can be administered over years without disadvantage for the patients

10. The high response rate in the present study may be a consequence of patient selection and standardization of instillation therapy Modified Potassium Test Easier applicable criteria facilitates diagnosis, with earlier initiation of therapy and better outcomes

11. The patients received weekly Hyaluronan instillations until symptoms resolved as to patients judgement or if instillation therapy turned out to be ineffective after a maximum of 10 instillations Instillation therapy was only performed in patients who were able to retain the instillation for 2 hours

12. The questionnaire was identical before and after the therapy Average number of instillations: 12

13. Response rate after initial instillation therapy with other GAG substituents: 56% Heparin 45% Chondroitin sulfate 44% PPS Long-term results do not exist for these substances